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Cited by 146Suicide and Self-Harm StudiesStress Responses and CortisolHomicide, Infanticide, and Child Abuse

Cortisol reactivity and suicidal behavior: Investigating the role of hypothalamic-pituitary-adrenal axis responses to stress in suicide attempters and ideators

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O’Connor, Daryl B., Green, Jessica A., Ferguson, Eamonn, O’Carroll, Ronan E., O’Connor, Rory C.·2017·Psychoneuroendocrinology
DOI 10.1016/j.psyneuen.2016.10.019
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Abstract

Every 40s a person dies by suicide somewhere in the world. The causes of suicidal behavior are not fully understood. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, is one potential risk factor. The current study aimed to investigate whether cortisol reactivity to a laboratory stress task differentiated individuals who had previously made a suicide attempt from those who had thought about suicide (suicide ideators) and control participants. One hundred and sixty participants were recruited to a previous attempt, a suicidal ideation or a control group. Participants completed background questionnaires before completing the Maastricht Acute Stress Test (MAST). Cortisol levels were assessed throughout the stress task. Measures of suicide behavior were measured at baseline, 1 month and 6 month follow-up. Participants who had made a previous suicide attempt exhibited significantly lower aggregate cortisol levels during the MAST compared to participants in the control group; suicide ideators were intermediate to both groups. This effect, however, was driven by participants who made an attempt within the past year, and to some degree by those with a family history of attempt. Participants who made a suicide attempt and had a family history of suicide exhibited the lowest levels of cortisol in response to stress. Finally, lower levels of cortisol in response to the MAST were associated with higher levels of suicidal ideation at 1-month follow-up in the suicide attempter group. These results are consistent with other findings indicating that blunted HPA axis activity is associated with some forms of suicidal behavior. The challenge for researchers is to elucidate the precise causal mechanisms linking stress, cortisol and suicide risk.

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  • Adults with a history of suicide attempts have more blunted cortisol reactivity to a Trier Social Stress Test than those with only suicidal ideation history or healthy controls.

    “adults with a history of suicide attempts have more blunted cortisol reactivity to a Trier Social Stress Test (TSST) than those with only suicidal ideation history or than healthy controls (Melhem et al. 2016, O’Connor et al. 2017)”

    From Adolescent Suicide as a Failure of Acute Stress-Response Systems. (2019) · cites this paper as O’Connor et al. 2017

    The Results (§3.1; page unavailable) report lower cortisol output in attempters than in healthy controls, but no significant difference between attempters and ideators. The Methods (§2.2; page unavailable) identify this study’s stress task as the Maastricht Acute Stress Test, not the TSST. The Introduction (§1; page unavailable) says the TSST study it discusses found no significant between-group difference in cortisol reactivity. (LLM, conf=0.92)

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  • The present findings extend two other studies demonstrating that blunted CORT in the context of psychosocial stressors predicts suicidal behavior.

    “The present findings extend two other studies demonstrating that blunted CORT in the context of psychosocial stressors predicts suicidal behavior [10,11].”

    From HPA axis response and psychosocial stress as interactive predictors of suicidal ideation and behavior in adolescent females: a multilevel diathesis-stress framework (2018) · cites this paper as [11]

    The Results (§3.5, page unavailable) find that lower cortisol secretion during a laboratory stress task predicted greater suicidal ideation one month later, but only among participants with a prior suicide attempt. The Discussion (§4, page unavailable) also reports lower stress-related cortisol output in prior attempters than controls. The broader claim that blunted cortisol predicts suicidal behavior is not fully supported: the paper did not establish prediction of future suicide attempts. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The blunted CORT responses observed in adults with suicidal behavior may be observable in adolescent females.

    “The blunted CORT responses observed in adults with suicidal behavior [10,11] may be observable in adolescent females.”

    From HPA axis response and psychosocial stress as interactive predictors of suicidal ideation and behavior in adolescent females: a multilevel diathesis-stress framework (2018) · cites this paper as [11]

  • Two adult studies demonstrated blunted CORT to psychosocial stress among those with suicidal behavior relative to controls or those with suicidal ideation only.

    “Two adult studies (N = 160, 208) demonstrated blunted CORT to psychosocial stress among those with suicidal behavior relative to controls or those with suicidal ideation only [10,11].”

    From HPA axis response and psychosocial stress as interactive predictors of suicidal ideation and behavior in adolescent females: a multilevel diathesis-stress framework (2018) · cites this paper as [11]

  • TSST studies find lower pretask baseline cortisol and blunted total cortisol output in suicide attempters compared with nonattempters, while heightened cortisol response to stress appears confined to attempters with higher impulsivity and aggression.

    “TSST studies find lower pretask baseline cortisol (161, 162) and blunted total cortisol output (162, 163) in suicide attempters compared with nonattempters, while heightened cortisol response to stress appears confined to suicide attempters exhibiting higher levels of impulsivity and aggression (164).”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [163]

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Authors
O’Connor, D. B., Green, J. A., Ferguson, E., O’Carroll, R. E., & O’Connor, R. C.
Affiliations
  • University of Leeds (GB)
  • University of Nottingham (GB)
  • University of Stirling (GB)
  • University of Glasgow (GB)
ORCID
Venue
Psychoneuroendocrinology
Publisher
Elsevier BV
Published
2017-01
Volume
75
Pages
183-191
ISSN
0306-4530 (ISSN-L)
DOI
10.1016/j.psyneuen.2016.10.019
OpenAlex
W2539234916
Cited by
146
References
41
Citations by year
2026: 8 · 2025: 14 · 2024: 11 · 2023: 20 · 2022: 16 · 2021: 14 · 2020: 18 · 2019: 14 · 2018: 25 · 2017: 6
FWCI
20.08
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychoneuroendocrinology (acceptedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
  • Stirling Online Research Repository (University of Stirling) (submittedVersion, public-domain)
  • Nottingham ePrints (University of Nottingham) (submittedVersion)
Funders
US Department of Defense (W81XWH-12-1-0007)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
cortisol response, hypothalamic-pituitary-adrenal axis, suicide attempts, suicidal ideation, acute stress response, Maastricht Acute Stress Test, family history of suicide, suicide risk
MeSH terms
Adolescent, Adult, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Pituitary-Adrenal System, Stress, Psychological, Suicide, Attempted, Young Adult, Suicidal Ideation

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